Obesity is an important risk factor for the development of fatty liver. The current diagnostic indexes of obesity cannot effectively reflect the role of adipose tissue distribution in the development of fatty liver.

To assess the correlation of the baseline visceral adiposity index (VAI) and the Chinese visceral adiposity index (CVAI) with the risk of fatty liver.

This was a retrospective cohort study involving 17 086 adults receiving physical examination at the Health Management Center of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, from February 2018 to November 2021. Physical examination records were reviewed by the electronic information system of the Health Management Center, and baseline characteristics, physical examination findings, laboratory testing and equipment inspection data were collected. Fatty liver was determined by follow-up abdominal ultrasound and computed tomography (CT). Follow-up was ended in December 2022, and follow-up events were recorded as the interval from non-occurrence of fatty liver at baseline to the first onset of fatty liver or at the end of the follow-up. Subjects were divided into fatty liver group and non-fatty liver group. Baseline VAI and CVAI were compared between groups. They were further divided into four groups based on the quartiles of baseline VAI and CVAI, and the incidence of fatty liver was compared. The correlation of VAI and CVAI with fatty liver was identified by Cox regression. The potential of VAI and CVAI in predicting fatty liver was assessed by the receiver operating characteristic (ROC) curves. Differences in the area under the curve (AUC) between VAI and CVAI were compared by the Delong's test.

The mean age, BMI and follow-up period of the subjects were (44.3±13.2) years old, (23.2±2.6) kg/m², and (2.7±1.1) years, respectively. By the end of follow-up, fatty liver was detected in 2 523 (14.8%) subjects. The incidence of fatty liver was significantly higher in men than women [19.4% (1 837/9 461) vs. 9.0% (686/7 625), P<0.001]. The VAI and CVAI of the fatty liver group were significantly higher than those of the non-fatty liver group (P<0.05). Trend testing showed that the incidence of fatty liver significantly increased with the increasing baseline VAI (χ²_trend=1 034.9) and CVAI (χ²_trend=1 334.8) (both P<0.001). Multivariate Cox regression showed that the risk of fatty liver in the VAI-Q4 group and CVAI-Q4 group was 2.579 times (95%CI=2.088-3.186) and 3.375 times (95%CI=2.488-4.576) that of the VAI-Q1 group, respectively. The ROC curve showed that the AUC of CVAI in predicting fatty liver was greater than that of VAI (0.737 vs. 0.708, P<0.001). Stratified analysis showed that CVAI was significantly correlated with the occurrence of fatty liver in gender, age and BMI subgroups (P<0.001) .

Baseline CVAI is significantly correlated with fatty liver development, and superior to VAI in predicting fatty liver.

肥胖是脂肪肝发生的重要危险因素，但肥胖的诊断指标不能有效反映脂肪组织分布在脂肪肝发生中的作用。

评估基线内脏脂肪指数（VAI）及中国内脏脂肪指数（CVAI）与脂肪肝发生风险之间的相关性。

本研究为回顾性队列研究，纳入2018年2月—2021年11月于南京大学医学院附属鼓楼医院健康管理中心的17 086名成年体检人群作为研究对象。通过健康管理中心的电子信息系统查阅健康体检档案，收集基本信息、一般体格检查、实验室检查指标及器械检查结果。根据随访的腹部超声和CT结果，判断是否发生脂肪肝。随访截至2022年12月。终点事件为基线无脂肪肝至首次发生脂肪肝或末次随访时间。根据随访是否发生脂肪肝分为两组，比较两组基线VAI、CVAI。根据基线VAI、CVAI的四分位数水平，将人群各分为4组（Q1、Q2、Q3、Q4组），比较4组的脂肪肝发生率。采用Cox回归分析评估VAI、CVAI与脂肪肝发生的相关性，并通过受试者工作特征（ROC）曲线评估VAI、CVAI对脂肪肝发生的预测价值，采用Delong's检验比较VAI、CVAI的曲线下面积（AUC）差异。

纳入的受试者平均年龄（44.3±13.2）岁，平均BMI（23.2±2.6）kg/m²，平均随访时间（2.7±1.1）年。截至随访结束，2 523例（14.8%）受试者发生脂肪肝。其中男性[19.4%（1 837/9 461）]脂肪肝发生率高于女性[9.0%（686/7 625）]（P<0.001）。脂肪肝组VAI和CVAI均高于未发生脂肪肝组（P<0.05）。趋势性检验分析结果显示，随着基线VAI、CVAI水平的增加，脂肪肝发生率也增加（χ²_趋势=1 034.9、1 334.8，P<0.001）。多因素Cox回归分析结果显示，VAI-Q4组和CVAI-Q4组发生脂肪肝的风险分别是VAI-Q1组的2.579倍（95%CI=2.088~3.186）和CVAI-Q1组的3.375倍（95%CI=2.488~4.576）。ROC曲线显示，CVAI预测脂肪肝的AUC大于VAI的AUC（0.737与0.708，P<0.001）。分层分析显示，CVAI在不同性别、年龄及BMI分组中，CVAI-Q4组均与脂肪肝发生相关（P<0.001）。

基线CVAI与脂肪肝发生显著相关，且CVAI对脂肪肝发生的预测能力优于VAI。